Biomedical subjects
Publications and source records attributed to G Fournier.
The clinical and histopathologic features of three cases of oxyphil cell adenomas (oncocytomas) include two cases involving the lacrimal sac and one involving the caruncle. These lesions generally occur in the caruncle of elderly women, although they have been reported to involve the conjunctiva, lacrimal sac, and rarely the lacrimal gland. They are usually controlled by wide local excision.
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Self-hemodialysis in a limited-care facility could be a good alternative for patients who are reluctant to home dialysis for several reasons. Through reduction of nursing personnel and elimination of physician attention at each dialysis, self-hemodialysis in a limited-care facility, where the patient dialyses himself and cleans his own machine without assistance, has reduced the cost to about one-half of center cost. From March 1980 to December 1982, out of 65 dialysed patients from Beauce and Perche Area, 33 patients were treated in the Hemodialysis Unit-Chartres Hospital (50.8%), only 5 were on home dialysis (7.6%), 15 were on CAPD (23.1%) and 12 were on self-hemodialysis in a limited-care facility (18.5%). Self-hemodialysis is a practical addition to various modalities treating end-stage renal disease and, in our experience, full compliance to the dialysis regimen was achieved in all patients.
Changes in blood bicarbonate, phosphate and lipid were followed up on 9 patients as they are dialyzed with an acetate containing dialysate (AC) during 2 years and with a bicarbonate containing dialysate (BC) during 2 more years. The mean (+/- SD) predialysis concentration of blood bicarbonate was 23.11 +/- 1.09 mmol/L on AC period and 26.72 +/- 1.26 mmol/L on BC period. The new bicarbonate concentration steady state was reached with a delay of about 3 months. The mean (+/- SD) predialysis phosphate concentration was lower during BC period (1.73 +/- 0.17 vs 1.95 +/- 1.26 mmol/L). Although the changes were not significant, less aluminium hydroxide (4.8 +/- 0.8 vs 6.0 +/- 1.3 g per day) was necessary to control blood phosphate during BC period. The most striking changes in this long term study was the tolerance of the patients on bicarbonate dialysis, where hypotension episodes and muscles cramps were reduced by 50% and headache, nausea and vomiting disappeared almost completely. Conversely, no significant changes in lipid status with changing dialysate could be found. The results of this long term study provide strong support for promoting bicarbonate containing dialysate for all hemodialyzed patients.
The methodology of the "Pressure-Flow-Perfusion System' used in the "Whitaker Test' was examined for factors which influence intrinsic resistance of that system. Considerable pressure changes were incurred by varying the concentration of sodium diatrizoate, perfusing needle, temperature and flow rates. For each renal pressure-flow-perfusion test, the resistance must be determined because of the effect of each variable in altering the intrinsic resistance.
Changes in pH and blood gases were studied during hemodialysis with both acetate and bicarbonate dialysates. During acetate dialysis, PaO2 and PaCO2 decreased significantly (P less than 0.05) from 101 +/- 2 to 93 +/- 3 mmHg and from 34.4 +/- 1.0 to 31.8 +/- 0.9 mmHg, respectively, whereas during bicarbonate dialysis neither parameter changed significantly. The final pH was 7.45 +/- 0.01 during acetate dialysis and 7.50 +/- 0.02 during bicarbonate dialysis. Plasma bicarbonate rose immediately and progressively from 18.9 +/- 0.8 to 26.8 +/- 0.9 mmol/L with bicarbonate dialysis, whereas the increase was moderate, from 19.6 +/- 0.6 to 22.3 +/- 0.5 mmol/L, with acetate dialysis. These data indicate that dialysis-induced hypoxemia was prevented and correction of acidosis was more adequate with bicarbonate dialysis. During a two-year period on bicarbonate dialysis, total cholesterol, HDL-cholesterol, and triglycerides did not change significantly when compared to acetate dialysis. The most striking change was the increased tolerance to dialysis with bicarbonate dialysis, which included a 50% reduction in hypotensive episodes and muscle cramps and an almost complete absence of headache, nausea, and vomiting.
The malleus appears to provide an effective solution in cases where the incus is absent and the upper part of the stapes cannot be employed, and when sound energy has to be retransmitted from the drum and the handle of the malleus to the labyrinth fluid. Total removal of the foot of the stapes with vein interposition is associated in nearly all cases. The method is not employed in patients with unfavorable positions of the ear-drum or handle of the malleus, the preferred procedure in the cases being the establishment of a direct communication between the ear-drum and the fenestra vestibuli, good results have been obtained.
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Dust was collected from 41 homes distributed in valleys, on ridges, near freeways and along shorelines. Acari were found in 40 of the 41 beds of these home in high concentration; Dermatophagoides represented 92.6%; all were D. pteronyssinus.
A hemodialyzed woman with radiologically and histologically proven osteomalacia presents a spontaneous fracture that is associated with aluminium intoxication. The hyperalbuminemia (16,6 mumol/1) was not caused by the aluminium contained in the dialysate fluid but by oral ingestion of aluminium gel in a patient presenting hyperabsorption of this metal. Increased absorption could be demonstrated by oral administration of aluminium hydroxide (2 x 12 g A1 (OH)3 spread over 48 hrs) whereas the same test failed to reveal hyperabsorption in two other hemodialyzed patients. The precise mechanism of increased absorption of aluminium is not known. It is concluded that increased digestive absorption of aluminium should be investigated in patients with kidney failure treated with aluminium gel and presenting high blood levels of this metal.
After exchange transfusion by an emulsion of fluorocarbons (Fluosol 43) in rats, an increase in fluorocarbons and 131I-labelled albumin was observed. These changes suggest a transfer of water from vascular to interstitial space possibly owing to the inability of the emulsion to reproduce the oncotic pressure of normal blood.
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